Whenever people think of at-home care, generally it’s tied to remote monitoring or at-home diagnostics or temporary hospital-at-home programs. But at-home care now includes palliative care. In this month’s pivot podcast, I speak with the chief medical officer of Vynca, an innovative company in the world of palliative care that is providing serious disease management at home.
Some of my notions about hospice and palliative care were clarified so I urge you to listen to the podcast, read the AI-generated transcript or view the YouTube video below.
Here’s a video of the interview:
Here’s an AI-generated transcript of our episode:
Arundhati Parmar: Hello and welcome to MedCity News’ Pivot Podcast. I’m your host, Arundhati Parmar. In this episode, we’re talking about the evolution of home health. When we talk about home health, we immediately think about remote monitoring, or at-home diagnostic testing, or hospital, uh, at-home programs after a discharge.
But what about palliative care? Traditionally, we have looked at palliative care as something that people receive in the hospice setting, but now that has been shifting also to the home. One company that has been innovating in this space is Vinca. In fact, it doesn’t even describe itself as a palliative care company.
Arundhati Parmar: Welcome, Jill, to the MedCity Pivot Podcast.
Jill Schwartz-Chevlin: Thank you for having me today.
Arundhati Parmar: So we’ve never done an, a podcast episode on home health as it ties to palliative care or serious illness management, so let’s start there. My understanding is that a lot has happened in the last five to seven years, especially, uh, during COVID.
Uh, palliative care, and I had an older brother who died of cancer nine years ago, so- Sorry … you know, he, we would have a sort of hospice nurse come visit him. So it wasn’t something, I mean, we, at the time we were all expecting him to recover and all of that, um, so we didn’t think too much of it. But traditionally, palliative care has already been, it has always been understood as something you get in a hospice setting.
So I wanted you to paint a picture for us and sort of explain how that has become something that people are receiving at the home, at their own home, in the convenience of their own home.
Jill Schwartz-Chevlin: Yeah. So thank you for the opportunity to talk about this. I think that palliative care has been very much misunderstood.
Mm-hmm
Palliative care is, uh, primarily, uh, about, uh, providing relief of symptoms, whe- whether it’s pain, stress, anxiety, um, for those with serious illness, and it’s ensuring that the patient’s wishes are paramount.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: This palliative care is typically provided through a team-based approach. But if we think about why it’s been so misunderstood, we have to look back at, at how palliative care has come to be.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: To start with, palliative care has primarily been provided through hospital systems.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: And when patients are in the hospital and palliative care teams are asked to provide care- This is when the palliative care team starts talking about hospice and end of life.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: When we start thinking, and so now we’re at a tipping point where more than 75% of hospitals actually have palliative care teams throughout the country.
That’s right. This is fabulous.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: However, it has misrepresented the, the service of palliative care and the specialty of palliative care for the community-based palliative care provision.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: And so people take that idea of end of life hospice because it’s, that’s what’s offered in the hospital, and say that’s what it is in the community.
Right. When in fact, in the community, it looks very, very different.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: So how it looks in the community is that in oncology practices, palliative care is provided to relieve the symptoms related to chemotherapy- Right … and radiation. Mm-hmm. For palliative care for, um, patients who have chronic pain, that looks very different because now those palliative care specialists are really focused on pain management.
Arundhati Parmar: Right.
Jill Schwartz-Chevlin: And for our patients who have serious illness, like advanced c- congestive heart failure, advanced COPD, people who are living with chronic metastatic disease, which, um, hasn’t been the case up until the last several years- That’s right … now that we have various different treatments for, uh, metastatic cancer, um, palliative care is about managing those chronic illnesses and addressing symptoms in, you know, that those patients have, while addressing, while, uh, y- adjusting the care based on where the patient is in their illness trajectory.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: So palliative care, while it’s gotten a very different name, um, and it looks different depending on the, um, the location of where that’s being provided, um, it’s, it’s, it, it’s now coming into favor to be- Mm-hmm … part, uh, like a collaborating team with the specialty, uh, practices and with the PCPs in the community.
Arundhati Parmar: And then how do you, uh, you know, I mean, let me take a step back. You began as an advanced care m- uh, management, a advanced care planning sort of company, right? Uh, trace for me your company’s evolution to where you are today.
Jill Schwartz-Chevlin: Yeah, so we started, uh, off with an advanced care planning platform
Arundhati Parmar: Mm-hmm
Jill Schwartz-Chevlin: Um, but that was never gonna be the end point.
Arundhati Parmar: Okay.
Jill Schwartz-Chevlin: Right? The, the thinking about it is that when you start with advanced care planning, it’s really a starting point for having these discussions so that we can have conversations with patients about their roadmap, about what they want.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: And so it’s n- a natural progression into a palliative care company because now we can then really, um, uh, oversee and, uh, and be a collaborating team with the specialists in the community- Mm-hmm
to help to address the various symptoms, concerns, problems that that patient is having that typically drive high utilization and high med cost. And so it’s, it’s been a transition over the past 15 years. Mm-hmm. We’ve been providing palliative care, uh, in the home for the last 15 years, um, you know, working with, uh, uh, patients who require, uh, either in-home p- in-person care or telehealth care.
Mm-hmm. So we do provide advanced care planning platform. We also have, um, a palliative care service, uh, and we also have enhanced care management services.
Arundhati Parmar: Explain to me how you sort of distinguish yourself from more, the larger, um, you know, sort of palliative care company like a med… I always have trouble pronouncing the company.
Amedisys, and then maybe Empath Health or Axon Care, CenterWell Home Health. How do you sort of, um, distinguish yourself?
Jill Schwartz-Chevlin: Yeah. So, uh, we’re a value-based palliative care company. We are a specialty palliative care company. Um, and, uh, our company is, uh, is, works with an interdisciplinary care team, so we have nurses, nurse practitioners, physicians.
Um, we have chaplains, uh, and, uh, and we, and social workers. Mm-hmm. And so we ho- we, we help to address the whole person care-
Arundhati Parmar: Okay …
Jill Schwartz-Chevlin: uh, for those patients. Um, we primarily f- you know, we’ve been focused primarily in California- Mm-hmm … uh, to help to support their Medicaid patients- Mm-hmm … uh, with, uh, palliative care services under their Medicaid benefit for palliative care for the past- Mm-hmm
10 years or so. And, um, and that has primarily been the main focus- Mm-hmm … uh, of the services that we’ve provided on the w- uh, really on the West Coast. Mm-hmm. Um, and we are now expanding into other areas, and we are, uh, looking to be the first provider for the new Medicaid benefit in, for the state of New Jersey.
Okay. Only three states have- Mm-hmm … um, have, uh, stepped up to provide a Medicaid benefit. Okay. So we are, are working, uh, to make sure that we can be a provider there. Um, and we also work with other, um, Medicare, uh, providers. So we, uh, we, we provide, um, various, um… We serve various lines of business- Okay … for various, uh, health plans- Okay
uh, throughout the country. Um, and we are expanding, uh, uh, eastward-
Arundhati Parmar: Okay …
Jill Schwartz-Chevlin: from, from- This is- … from the West Coast. Yeah.
Arundhati Parmar: This is a perfect segue, but before I get to that, um, very quickly, you said there are three states that provide the, the Medicaid benefit, benefit for palliative care, California and New Jersey.
Which is the third one?
Jill Schwartz-Chevlin: Uh, Hawaii.
Hawaii. Okay, perfect. So the segue, after a brief pause. Um- So Medicare does not have a benefit for palliative care, which is, uh, a problem. Um, so b- how, how much are you dependent on individual states from a Medicaid perspective, ’cause that is within their jurisdiction? Um, I mean, your business growth will largely depend on wh- when states realize that th- this is something that they need to do, and when they frankly have the money to be able to do so.
So give me a sense of, um, you know, sort of the trajectory of expansion, because it seems like it’s largely dependent on what individual states are doing.
Jill Schwartz-Chevlin: Yeah, so it’s an interesting question. Um, when w- when we contract with payers, we’re contracting on a state basis anyway, whether it’s for a Medicare, uh, Advantage plan or- Mm
whether it’s for a Medicaid plan. Okay. Um, uh, we can also partner with health plans that cover many states as well, but generally it’s, there’s a, there’s a state focus to the c- the care that’s provided. Um, and so you’re exactly right. Traditional Medicare unfortunately does not cover this service right now.
Arundhati Parmar: Right.
Jill Schwartz-Chevlin: Whereas the Medicare Advantage plans-
Arundhati Parmar: Mm-hmm …
Jill Schwartz-Chevlin: in many states are- Do … covering it, right? So health plans are covering, um, uh, palliative care because they realize there’s a significant cost savings related- Right … to, uh, pairing palliative care with other s- other care that the patient is getting as an additional layer of care.
Uh, and so Med- So let me
Arundhati Parmar: stop you just a second. Yeah. There’s cost savings from, you know, preventing ER admissions?
Exactly. So there’s, um, there’s a, you know, a, a, a, a, a 42%, uh, reduction in, uh, ER admissions, a 53% reduction in hospitalizations- Mm-hmm … um, that we’re seeing. So there’s significant cost savings related to providing palliative care, and one would say, like, why is that the case?
Um, when we think about patients having whole-person care, a whole care team wrapping the care around those patients, addressing their fears and worries, addressing the caregiver’s fears and worries, um, addressing, uh, the symptoms proactively, anticipating those symptoms before they get them-
Arundhati Parmar: Right …
Jill Schwartz-Chevlin: creating an opportunity to be able to have, um, care in the home prior to the exacerbation- Mm-hmm
an ongoing relationship with your care team so someone’s checking in on you. I’ll give you an example. A patient with metastatic pancreatic cancer was playing golf a month ago.
Arundhati Parmar: Okay.
Jill Schwartz-Chevlin: And they were feeling otherwise well And their primary, um, uh, contact point is with the oncology office.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: But no one’s checking in on them on a weekly or daily basis to, to see how they’re doing.
Right. And all of a sudden that patient ends up in the emergency room and, um, and with symptoms, really exacerbated symptoms, with significant pain, um, and, uh, and a lot of fear and anxiety around what’s going on. Mm-hmm. And so our team can help to supplement the care that that oncologist’s office is providing- Okay
um, and be able to have a care plan that addresses the needs of that patient, um, as they, as they might progress.
Arundhati Parmar: Okay. Now, the, the way you described it, it sound like these folks that you work with, like the, um, behavioral, uh, you know, uh, providers or sh- chaplains or the virtual care providers, they seem like they’re on staff.
Is that correct?
Jill Schwartz-Chevlin: Correct.
Arundhati Parmar: So how many providers work with you on a full-time basis?
Jill Schwartz-Chevlin: Yeah. So we have providers that, um, that cover m- multiple different states.
Arundhati Parmar: Okay.
Jill Schwartz-Chevlin: And so we, um, we have providers that are, um, that, uh, are, uh, that can be all over the country, but actually do provide care specifically in all the different states that w- that we provide care.
So we’re currently in five states. Mm-hmm. We’re actually in a … And we, we’ve just started in New Jersey. We’re just gonna be starting in New Jersey. We’re on that precipice. Okay. So, um, and we’re hiring providers, so we’re actively looking for more providers- Mm-hmm … um, in various states. And, um, and we are, you know, we’re, we’re looking for, to invite m- you know, Medicare health plans- Mm-hmm
uh, to be able to, um, look to, uh, uh, to add this service as a, as an, uh, additional service, uh, to their, their existing care.
Arundhati Parmar: So the Medicare Advantage piece, it’s interesting. Y- you know, MA was on this huge trajectory upwards, and now there’s been a lot of scrutiny. There’s a lot of fraud. You know, companies are coming out, Humana and all those companies have come out of, um, you know, Medicare Advantage. [Editor’s Note: Actually Cigna sold its entire MA business.]
Um, sorry, am I … I don’t know if I’m saying that correctly. I think there was a large payer that dropped MA completely. Um, I’ll have to double-check and correct myself if I’m wrong. But it, there is a certain retrenchment in the world of Medicare Advantage, so how, when you approach payers now, do you see a different world, um, in terms of their receptivity to adding a new benefit, um, given sort of the flux that MA is in right now?
Jill Schwartz-Chevlin: It’s a great question. I think, um, there was a lot of emphasis on, um On revenue and reimbursement for the services, on comprehensive care, comprehensive assessments, there was a big focus on being able to do that, especially in, um, MA plans for early disease detection, trying to identify- Right … patients with the highest complexity, and looking- Mm
at it from that perspective. Um, there’s been a doubling down on the medical cost savings part-
Arundhati Parmar: Mm-hmm …
Jill Schwartz-Chevlin: of the model. Uh, and I think that’s where palliative care comes in. Of course. And it’s been identified through many studies, um, and over and over, over the last five to 10 years.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: And it’s been consistently shown that palliative care services is part of that cost benefit.
Arundhati Parmar: Okay.
Jill Schwartz-Chevlin: And so if we can save in, um, 43% in ER visits, 52% in inpatient admissions, we can provide an 81% reduction in symptom burden, um, this is, this is significant. The other thing that we d- are able to do is, is increase our, uh, hospice length of stay and our hospice transitions. And these are things that unfortunately, uh, providers in the community are having a very difficult time to- doing.
Okay. This is not something that’s in their wheelhouse. Right. They have a much more difficult time talking to patients about the right time when hospice is appropriate, when that transition happens. Um, and so at Vinco, where we see patients in the last 12 months of life who are not yet appropriate for hospice, who are not necessarily looking to, to, to, to, um, to want hospice services at that time- Mm-hmm
um, we can help to step in, help with, uh, their symptom management, help to be able to have those difficult conversations, help to be able to transition those patients along- Mm-hmm … with their primary care providers and their specialists so that they’re- it’s a win-win-win. Okay. So- The patients have, you know, increased satisfaction- Right
the health plan wins, and the providers, um, feel less moral distress.
Arundhati Parmar: So I think you said increase the, the length of hospice stay. You mean decrease, right? You wanna reduce the amount of time that a single person spends in hospice. You’d rather have them be taken care of at home, and when it’s becomes absolutely impossible to do so, then they would shift and transition over to the hospice.
Jill Schwartz-Chevlin: So no. Um, I, I, I, I said increase length- Increase … of stay, and, and I’ll explain why.
Arundhati Parmar: Yes, please.
Jill Schwartz-Chevlin: So people think hospice is a place to go.
Arundhati Parmar: Yes.
Jill Schwartz-Chevlin: You go to a hospice.
Arundhati Parmar: Right.
Jill Schwartz-Chevlin: When in fact, 90% of the care that hospice provides is in the home.
Arundhati Parmar: Oh, I see what you’re saying. Okay, not the transition to a physical facility, but sort of hospice care in the home, which includes palliative stuff.
Okay.
E-
Jill Schwartz-Chevlin: exactly. Mm-hmm. And so when hospices can start earlier, hospice is when patients have less than six-month life expectancy.
Arundhati Parmar: Right.
Jill Schwartz-Chevlin: Right? With usual, uh- I see what you mean … progression of their disease. Mm-hmm. So if hospice can start earlier, they’re getting the hospice nurses and the hospice team addressing- Mm-hmm
their symptoms and their care-
Arundhati Parmar: Right …
Jill Schwartz-Chevlin: much more intently than any of the other services in the community.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: Mm-hmm. So in my- Including r- including the services that palliative care can provide. I see what you’re saying. Makes sense. So hospice teams can see patients on a daily basis. Mm-hmm. They have the support to be able to see those patients.
So we want patients to get their hospice services- Mm-hmm … as early as they can-
Arundhati Parmar: Mm-hmm …
Jill Schwartz-Chevlin: so that ultimately the patient can, um, can live better- Okay … and live happier and have greater quality of life, uh, under hospice services- Okay … um, uh, if they get transitioned, and they, they, there are fewer hospitalizations.
Arundhati Parmar: Okay. So then let me ask another sort of related question. If, if, if this is so, then it might make sense, and I’m assuming you’re already doing this, but I need to check, uh, you obviously are expanding into states that have this Medicare benefit, but there’s also the whole hospice infrastructure, so, and, and they are not very good at having services in the home.
So does it make sense to, you know, partner with hospice companies that deliver care in the, um, in their own facilities, but that they can also, you know, deliver those services through you in a person’s home?
Jill Schwartz-Chevlin: Yeah, so we don’t deliver hospice services.
Arundhati Parmar: Okay.
Jill Schwartz-Chevlin: We don’t deliver hospice services. Okay. So what I’m…
So we de- we deliver palliative care services.
Arundhati Parmar: Yes, sure.
Jill Schwartz-Chevlin: Hospice services is for services in the last six months of life.
Arundhati Parmar: And what would they be? How is that so different from palliative care?
Jill Schwartz-Chevlin: So in a, in pa- in, in hospice services, where, um, patients opt to forgo curative treatment-
Arundhati Parmar: Yes, fair enough …
Jill Schwartz-Chevlin: they make a decision that they’re not going to have active management.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: And they have nurses and social workers and chaplains primarily seeing them in the home. Right. And they do symptom management, and this is to help to manage their symptoms- Sure … more aggressively, right? Yes. And so to provide comfort care.
Arundhati Parmar: Mm-hmm.
Jill Schwartz-Chevlin: Many of our patients are still getting, uh, active management of their disease.
Okay. They still want to see their specialists. They still want to get their treatments. Um, they may be getting chemotherapy or radiation. They may need to go, um, and get transfusions for various, you know, for whatever that might, you know, their disease may call for. Okay. Um, and they’re still wanting to get more aggressive management, which means that if they, i- if they need to go to the hospital, they would prefer to do that.
Fair enough. So
Arundhati Parmar: in, in the continuum of care, so to speak, uh, you are earlier on in the, in the stage. Okay, okay. Um- Correct … tell me a little bit about Medicare. Uh, how important do you think, and this will sort of be my final question, how important do you think it is for CMS to understand that this is a Med- Medicare, this is a benefit that Medicare should provide, especially now that the US is a very old nation, right?
In terms of demographics, we have more old people than young people. So how important is it for Medicare to understand that this is a benefit that should be provided?
Jill Schwartz-Chevlin: Yeah, it’s a, uh, it’s, it’s critically important. Currently, um, the way palliative care is being offered throughout the country right now, in the majority of cases, is fee for service.
What I mean is that the patient is seen- Sure … by a provider, and the provider gets riped, right? Right. It submits a claim and gets paid. Right. Unfortunately, that, that service, um, is not sustainable. Sure. And most palliative care companies that are linked to hospices are actually subsidized by the hospice because they can’t sustain their own care.
Arundhati Parmar: Right.
Jill Schwartz-Chevlin: So Medicare- Needs to, to, to revamp how they are reimbursing palliative care s- and to incentivize, um, you know, a team-based, value-based proposition so that outcomes, right, like increase in length of stay of hospice, increase the transition rate to hospice, um, making sure that there’s reduction in hospitalizations, right?
If they incentivized those outcomes- Mm-hmm … through a team-based approach and paid for a case rate during those months that the patient is getting that palliative care-
Arundhati Parmar: Mm-hmm …
Jill Schwartz-Chevlin: more patients can receive the right level of care.
Arundhati Parmar: Excellent. Well, Jill, thank you so much for your time today. I really appreciate it.
Jill Schwartz-Chevlin: Sure. My pleasure.
